Medicare definitions: Medicare glossary of terms

Having trouble understanding Medicare terms? Use our glossary of commonly used Medicare definitions and terms to get the answers you need.

Annual Enrollment Period The period from October 15 to December 7 when you can enroll in a Medicare Advantage plan with Part D or a stand-alone Prescription Drug Plan, or switch Medicare plans.

appealA process to request your Medicare health plan to reconsider or perhaps change the decision of denying your request for coverage for the medical care coverage that you want.

Centers for Medicare & Medicaid Services (CMS)The branch of the Department of Health and Human Services that administers Medicare.

catastrophic coverageThe part of the prescription drug benefit that kicks in after you have paid a certain amount in a calendar year.

coverage gapA stage in the Part D drug benefit during which you pay a certain percent of prescription drug costs set by Medicare. Also known as the “doughnut hole,” the gap begins after your costs reach an initial coverage limit and ends after you have paid enough to become eligible for catastrophic coverage.

durable medical equipment (DME)Certain medical equipment that is ordered by your doctor for use in your home. Some examples are walkers, wheelchairs, and hospital beds.

Extra HelpFinancial assistance from Medicare to help cover Part D drug plan costs. Also known as the low-income subsidy (LIS). To determine if you are eligible for Extra Help or other government assistance, visit the Medicare website† or call us anytime to learn more.

formularyA plan’s list of covered prescription drugs.

grievanceAny expression of dissatisfaction (complaint) you make about us or one of our network providers or pharmacies, including a complaint concerning the quality of your care. This type of complaint does not involve coverage or payment disputes.

Initial Enrollment Period (IEP)The 7-month period when you first can enroll in Medicare (3 months before you turn 65, the month of your birthday, and the 3 months afterward).

low-income subsidy (LIS)See Extra Help.

MedicaidA joint federal and state program, separate from Medicare, that helps pay medical costs for people with low incomes, limited assets, and disabilities.

Medi-CalThe official name of the Medicaid program in California.

MedicareThe federal health insurance program for people age 65 and older. It is also available to some people under 65 who have certain disabilities, and to people with end-stage renal disease.

Medicare AdvantageSee Medicare Part C.

Medicare Advantage Open Enrollment Period (MA OEP)During this period, you can make a one-time election to:

add or drop Part D coverage

enroll in another Medicare Advantage plan

disenroll from your Medicare Advantage plan and return to Original Medicare

Individuals enrolled in either MA-PD or MA-only plans can switch to:

MA-PD

MA-only

Original Medicare (with or without a stand-alone Part D plan)

The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.If you are enrolled in a Medicare Advantage plan as of January 1, your MA OEP period is January 1 to March 31. If you are a new Medicare beneficiary who is enrolled in a Medicare Advantage plan during your initial Enrollment Election Period, your MA OEP is the month of entitlement to Part A and Part B through the last day of the 3rd of the entitlement.

Medicare Cost planA plan offered through private health care companies that covers Part B services, and may include Part A services, as well as other benefits, such as the option of receiving prescription drug coverage (Medicare Part D). Cost plans allow you the option of receiving care from non-plan providers by paying Original Medicare deductibles and coinsurance.

Medicare Part ACoverage that helps pay for hospital stays, skilled nursing care, some home health services, and hospice care.

Medicare Part BCoverage that helps pay for physicians’ services, outpatient care, and other medical services not covered by Part A. Parts A and B together are known as Original Medicare.

Medicare Part C (Medicare Advantage)A plan offered by a private organization as an alternative to Parts A and B only. Part C plans and Cost plans may offer more benefits than Original Medicare and may include Part D coverage.

Medicare Part DPrescription drug coverage available as a stand-alone plan (PDP) or as part of a Medicare Advantage plan (MA-PD).

Medicare supplemental insurancePlans sold by private companies to supplement Original Medicare coverage. Also known as Medigap plans, they are not to be confused with Medicare Advantage (Part C) or Cost plans.

MedigapSee Medicare supplemental insurance.

Original Medicare (also known as Traditional Medicare or fee-for-service Medicare)Collective term for Medicare Parts A and B.

skilled nursing careTreatment that must be given or supervised by a registered nurse (RN), such as intravenous injections or tube feedings.

Special Enrollment Period (SEP)A time other than the annual election period or initial enrollment period when you may join, change, or drop a Medicare plan. An SEP can be triggered by certain events such as a change in residence.

Special Needs Plan (SNP)A Medicare Advantage plan for people who are institutionalized, or entitled to both Medicare and state Medicaid benefits, or have certain chronic conditions.

TTYA teletypewriter (TTY) is a communication device used by people who are deaf, hard-of-hearing, or have a severe speech impairment.

†Kaiser Permanente is not responsible for the content or policies of external Internet sites.

This information is not a complete description of benefits. Call 1-866-973-4584 toll free (TTY 711) 8 a.m. to 8 p.m.,
7 days a week, for more information.

You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.

In California, Hawaii, Oregon, Washington, Colorado, Georgia and the District of Columbia, Kaiser Permanente is an HMO plan with a Medicare contract. In Maryland, Kaiser Permanente is an HMO plan and a Cost plan with a Medicare contract. In Virginia, Kaiser Permanente is a Cost plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

For accommodation of persons with special needs at sales meetings, call 1-877-220-3956 (toll free) or TTY 711.

†Kaiser Permanente is not responsible for the content or policies of external Internet sites.